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WALMART PHARMACY 10-5169
CAH281304-00 Thayer County Memorial Hospital dba Thayer County Health Services
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Covered Entity Details
Entity Name
Thayer County Memorial Hospital dba Thayer County Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281304-00
Entity Address
120 Park Avenue
Hebron, NE 68370
Medicare Provider Number
281304
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian P Rokusek, President
(402) 768-4614
Contract Pharmacy Representative
Walmart
Tisha Campbell, Director of Contracting
(949) 872-4138
Signed By Date
4/6/2023
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